Care Gaps in Gout Management Within a Tertiary Academic Health System in Saudi Arabia: Implications for Quality Improvement.

BACKGROUND

Gout is a common, treatable inflammatory arthritis, yet adherence to guideline-based care remains suboptimal worldwide. Data from Saudi Arabia evaluating real-world gout care processes are limited.

METHODS

We conducted a retrospective cohort study of adults with a a physician-documented diagnosis of gout who newly initiated allopurinol within a tertiary academic health system in Riyadh, Saudi Arabia, from January 2022 through December 2024. Pharmacy records were used to identify eligible patients, and electronic medical records were reviewed to extract demographic, clinical, and treatment data. Adherence to American College of Rheumatology (ACR) 2020 guideline-derived quality indicators was assessed, including guideline-concordant initiation of urate-lowering therapy (ULT), serum uric acid (SUA) monitoring, achievement of SUA <6 mg/dL, and use of anti-inflammatory prophylaxis. Multivariable logistic regression was used to identify predictors of adherence.

RESULTS

Among 120 patients, 35.8% met ACR 2020 criteria for ULT initiation. SUA was measured within 6 months of initiation in 41.7% of patients, and at least annually in 61.7% of patients with at least 12 months of follow-up. Among 115 patients with at least 12 months of follow-up and at least one documented SUA measurement, 32.2% achieved SUA <6 mg/dL. Anti-inflammatory prophylaxis was received at ULT initiation by 15 out of 107 eligible patients (14%). Primary care management was independently associated with lower odds of meeting initiation criteria (OR 0.05, 95% CI 0.01-0.16) and of achieving the target SUA (OR 0.23, 95% CI 0.06-0.89) compared with rheumatology. Older age (OR 0.97, 95% CI 0.92-1.00) and male sex (OR 0.29, 95% CI 0.10-0.83) were also associated with lower SUA target attainment.

CONCLUSION

In this tertiary academic health system, guideline-recommended gout care processes were inconsistently executed across initiation, monitoring, target assessment, and prophylaxis domains. Primary care management was associated with lower odds of appropriate ULT initiation and target SUA attainment, and older age and male sex were also associated with lower target achievement. Standardized treat-to-target pathways supported by pharmacist- or nurse-led titration may improve performance.